Declining CMS rates have been a concern among physicians across the board, and spine surgeons are thinking about implications for the future of patient care as well as strategies to stay afloat.
The 2025 proposed physician fee schedule includes a 2.8% pay cut. And over the past three years, the CMS conversion factor has declined. Some physicians have dropped Medicare patients altogether.
According to a 2023 Kaiser Family Foundation report, 1.1% of non-pediatric physicians have dropped out of the Medicare program.
Among spine surgeons, concerns about declining reimbursements are bumping up against increased demand for orthopedic care.
"Changes in reimbursement models and insurance policies are certainly affecting the types of practices that surgeons are considering," Rachel Bratescu, MD, said. "The model of pure private practice is becoming less common, being largely driven by its known financial challenges, including inflation, rising costs (i.e. overhead and staffing), and declining reimbursements. Medicare reimbursement for spine procedures has been steadily decreasing over the last 15 to 20 years, which is relevant in the context of our growing aging population. If these trends in reimbursement continue, fewer surgeons may choose to accept these patients, all while the demand for care is projected to increase."
For some spine surgeons, dropping Medicare patients entirely was an option that has worked long-term. Ara Deukmedjian, MD, backed out of Medicare more than a decade ago. Medicare patients who still wanted to see him paid out of their pockets, and his practice has remained strong financially.
However dropping Medicare patients comes with its own obstacles.
"The challenges would be if you're in an area of the country where there's a lot of neurosurgical competition and you have a lot of providers, then patients may not want to pay cash to the provider who is not part of that Medicare," Dr. Deukmedjian said.